| NPI | 1063001220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN ST. PATRICK MAXWELL Executive Director 747-272-9348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2021-01-12 |